Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce joint pain and inflammation and are generally used first when rheumatoid arthritis (RA) is discovered. There are a large number of NSAIDs available.

NSAIDs are believed to work by blocking the effects of enzymes COX-1 and COX-2. These enzymes help produce a substance, prostaglandin, which triggers swelling and inflammation. By blocking the production of prostaglandin, NSAIDs are believed to help reduce inflammation.

What does it do? The way celecoxib works is not completely understood, but it is believed to be involved in blocking the COX-2 enzyme to decrease the production of prostaglandins.

How do I use it? Celecoxib is taken orally, usually twice a day.

What are some known side effects? Celecoxib can cause abdominal pain, diarrhea, indigestion, nausea, and dizziness. Celecoxib may increase the risk of heart attack, stroke, and blood clots. It may also increase blood pressure, worsen existing heart failure, and increase the risk of bleeding and ulcers. Pregnant women should not use this medication, especially if they are in their third trimester.

What does it do? The way diclofenac works is not completely understood, but it is believed to be involved in blocking prostaglandins that cause inflammation.

How do I use it? Diclofenac is taken orally 1 to 3 times a day, depending on the specific formulation.

What are some known side effects? Diclofenac can cause nausea, vomiting, diarrhea, heartburn or indigestion, abdominal pain, gas, loss of appetite, dizziness, headache, and rash. Diclofenac may increase the risk of heart attack, stroke, and blood clots. It may also increase blood pressure, worsen existing heart failure, and increase the risk of bleeding and ulcers. Pregnant women should not take diclofenac combined with misoprostol (Arthrotec®), and pregnancy should be ruled out before taking this medication.

What does it do? The way indomethacin works is not completely understood, but it is believed to be involved in blocking prostaglandins that cause inflammation.

How do I use it? Indomethacin is taken orally 2 or 3 times a day.

What are some known side effects? Indomethacin can cause vomiting, indigestion, diarrhea, constipation, headache, dizziness, spinning sensation, drowsiness, depression, and ringing in the ears. Indomethacin may increase the risk of heart attack, stroke, and blood clots. It may also increase blood pressure, worsen existing heart failure, and increase the risk of bleeding and ulcers.

What does it do? The way meloxicam works is not completely understood, but it is believed to be involved in blocking the COX-2 enzyme to decrease the production of prostaglandins.

How do I use it? Meloxicam is taken orally, usually once daily.

What are some known side effects? Meloxicam can cause indigestion, nausea, abdominal pain, diarrhea, skin rash, lightheadedness, and headache. Meloxicam may increase the risk of heart attack, stroke, and blood clots. It may also increase blood pressure, worsen existing heart failure, and increase the risk of bleeding and ulcers.

What does it do? The way naproxen works is not completely understood, but it is believed to be involved in blocking prostaglandins that cause inflammation.

How do I use it? Naproxen is taken orally 1 or 2 times a day, depending on the specific formulation.

What are some known side effects? Naproxen can cause heartburn, constipation, abdominal pain, nausea, diarrhea, indigestion, gastric bleeding, headache, dizziness, drowsiness, fatigue, lightheadedness, sweating, shortness of breath, swelling, ringing in the ears, disturbances in hearing, and skin problems. Naproxen may increase the risk of heart attack, stroke, and blood clots. It may also increase blood pressure, worsen existing heart failure, and increase the risk of bleeding and ulcers.

Many of the gastrointestinal side effects described for these NSAIDs can be minimized by taking NSAIDs with food or adding another medication to help protect the stomach lining. Serious side effects to watch out for include fluid retention, increases in blood pressure, ulcers, stomach bleeding, heart problems (including increased risk of heart attack or stroke), and kidney problems.

Talk to your health care provider to learn more about using NSAIDs for treating RA.